Granulomatous appendicitis in children: A single institutional experience

Abstract

Background: Granulomatous appendicitis (GA) is a rare entity, mostly mentioned in adults. There have been anecdotal case reports describing GA in the paediatric population. This study was aimed at reviewing the cases of appendectomies to assess the incidence and characteristics of GA in children in a tertiary care University hospital.

Materials and Methods: Records of children (<13 years age) with biopsy
proven granulomatous lesions in the appendectomy specimen, treated during 1991-2011, were analysed. Data regarding demography, clinical  presentation, radiological fi ndings, intra-operative fi nding, histology, diagnosis and follow-up were recorded and descriptively analysed.

Results: Twelve out of 1150 (1.04%) appendectomies were biopsy proven GA. Male to female ratio was 8:4. Four had Yersinia enterocolitis, two had Crohn’s disease (CD; one isolated Crohn’s Appendicitis, one Ileo-cecal  Crohn’ with appendicitis) and five were idiopathic. Remaining one case, initially diagnosed as idiopathic GA, developed full blown ileo-cecal CD at 2nd month post-operative. Age ranged between 4 and 11 years with  inflammatory bowel disease (IBD) affecting older children and Yersinia, seen in younger children. Majority (10/12) remained asymptomatic at a maximum of 5 years of follow-up. Two patients had recurrent symptoms; one with subacute obstruction (2 years follow-up) and another with fl aring of Crohn’s ileitis (2 months follow-up).

Conclusions: GA in children is a rare entity, with incidence of 1.04% and male preponderance in our series. Idiopathic causes were the most  common followed by Yersinia enterocolitis and CD. Although majority  remained asymptomatic, IBD should be ruled out in case of recurrence of  pain or alteration of bowel habit. Therefore, a long-term follow-up (at least for 5 years) of idiopathic GA is suggested in children.

Key words: children, Crohn’s, granulomatous appendicitis, idiopathic, Yersinia